Bilateral Middle Cerebral Artery Stroke: Stroke Chameleon—Diagnostic and Management Challenges

Abstract

The middle cerebral artery (MCA) territory is the most frequently affected area in stroke patients, and its neurological deficit depends on the extent of the infarct and hemispheric dominance. However, bilateral occlusion of the MCA is exceedingly rare, occurring in less than 1% of stroke cases. Bilateral MCA infarction is an exceptionally rare condition that often leads to poor outcomes, with patients often experiencing diffuse cerebral oedema, brain herniation, decerebral posturing, and, in some cases, death. We present a case of a 30-year-old gentleman who presented to a district hospital with status epilepticus, was transferred to a tertiary hospital for brain CT and was found to have bilateral MCA infarction. This case demonstrates that stroke can present with atypical or subtle symptoms, making it difficult to diagnose and treat, as symptoms may not follow the usual patterns and present with severe symptoms.